Throughout this course, you have identified, examined, and provided individual as well as collaborative analysis on multiple facets of risk management in the health care setting.

Addressing the knowledge you have gained, and building on that knowledge to add your evaluation of the role that the managed care organization (MCO) plays in today’s health care environment, develop a 250-500 word reflection to incorporate the following:

1. What is a health care organization’s administrative role regarding oversight of risk management policies and ensuring compliance with managed care organization (MCOs) standards?
2. What is your assessment of the value provided to an organization that stems from the regulatory statutes of a typical MCO? Consider the establishment of conflict resolution and risk management strategies within the health care organization from the employer/employee perspective as well as in regards to patient conflict circumstances.
3. What MCO responsibilities pertain to the Patient Protection and Affordable Care Act (PPACA) and Center for Medicare and Medicaid Services (CMS) focus on fraud, waste, and abuse laws?

Prepare this assignment according to the guidelines found in the APA Style Guide, located in the Student Success Center. An abstract is not required.

You must proofread your paper. But do not strictly rely on your computer’s spell-checker and grammar-checker; failure to do so indicates a lack of effort on your part and you can expect your grade to suffer accordingly. Papers with numerous misspelled words and grammatical mistakes will be penalized. Read over your paper – in silence and then aloud – before handing it in and make corrections as necessary. Often it is advantageous to have a friend proofread your paper for obvious errors. Handwritten corrections are preferable to uncorrected mistakes.

Use a standard 10 to 12 point (10 to 12 characters per inch) typeface. Smaller or compressed type and papers with small margins or single-spacing are hard to read. It is better to let your essay run over the recommended number of pages than to try to compress it into fewer pages.

Likewise, large type, large margins, large indentations, triple-spacing, increased leading (space between lines), increased kerning (space between letters), and any other such attempts at “padding” to increase the length of a paper are unacceptable, wasteful of trees, and will not fool your professor.

The paper must be neatly formatted, double-spaced with a one-inch margin on the top, bottom, and sides of each page. When submitting hard copy, be sure to use white paper and print out using dark ink. If it is hard to read your essay, it will also be hard to follow your argument. Assignment: Roles of Managed Care Organizations.

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Roles of Managed Care Organizations

Introduction

Managed care organizations (MCOs) are the largest segment of the healthcare industry. They provide medical services at lower costs than fee-for-service providers, but they also come with their own set of benefits and risks. Here’s what you need to know about managed care:

Managed care organizations come in various forms.

Managed care organizations come in various forms. The HMO, or health maintenance organization, is the most common managed care organization. In a hospital-based HMO, patients are assigned to one of many medical doctors and given specific treatments based on the doctor’s recommendations. The patient pays the HMO directly for all services rendered by the doctor.

A PPO plan provides a variety of benefits at low prices; however, it requires you to choose between different insurance companies when purchasing your plan each year. With an EPO (electronic preauthorization over-ride), you can see any physician without having to wait for approval from your insurance company first—but this comes at a price as well!

An IPA (individual purchasing arrangement) allows you to choose which doctor or hospitals treat you based on what best suits your needs rather than being forced into one option or another by having no choice but “your” physician’s office regardless if there’s room available due only because he’s already booked up through next week until further notice.”

Managed care organizations keep costs down by providing medical services at the lowest possible prices.

Managed care organizations (MCOs) are able to negotiate better prices with doctors and hospitals. This means that you can receive medical services at the lowest possible cost. MCOs also have the ability to provide services at lower costs because they use a variety of strategies, including:

• Negotiating deals with providers

• Using network plans or risk pooling arrangements that help spread out expenses over large groups of people

• Reducing administrative costs through managed care networks

Managed care organizations are generally more efficient than fee-for-service providers.

The efficiency of a managed care organization is a good thing. There are many reasons for this, but it all comes down to one thing: MCOs can reduce costs by providing medical services at the lowest possible prices.

The most obvious way that MCOs save money is by using some combination of technology and standardized processes (which we will discuss later) to reduce overhead costs. For example, if you were an employer with one employee who required multiple medications each day and was taking them in separate bottles from different pharmacies (and not all at once), then your costs would be higher than they might otherwise be because you would have had multiple trips made between home and work every day—and those trips would take longer than if you had just brought everything home with one trip instead!

MCOs offer a wide range of patient services.

As an MCO, you can offer many different services to your patients. Some of these include:

• Helping patients find the right doctors and hospitals

• Helping patients get the care they need (e.g., medical treatment)

• Saving money on health insurance premiums or copays by using an HMO model with a network of providers who accept your plan’s network contracts and procedures

Many MCOs also offer some sort of managed care option for their members. This means that instead of having all aspects of their health covered by one plan like traditional health insurance plans do, they are divided into smaller groups based on age or other factors such as geography or family size

Managed care organizations are a valuable part of American healthcare.

Managed care organizations are a valuable part of American healthcare. They help keep costs down and provide a wide range of services, including primary care physicians and specialists. In addition, they are more efficient than fee-for-service providers because they don’t have to worry about making money on each service they provide; instead, the organization focuses on keeping its members healthy and affordable health insurance premiums.

Conclusion

MCOs are an important part of the healthcare system and provide many benefits to patients. They can help keep costs down, offer a wide range of services and more efficiently deliver medical care. MCOs will continue to be an essential part of America’s health care landscape for years to come